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What We Learned from the First Open Enrollment Period, and What to Expect from the Second

Nov 18, 2014, 10:32 AM, Posted by David Adler, Lori K. Grubstein

A man fills out an insurance application

It seems like just yesterday we were celebrating the victories from the first open enrollment period under the Affordable Care Act. More than 8 million consumers signed up for coverage through state and federal marketplaces, and millions more enrolled in Medicaid.

As the spring of success gave way to the summer of planning, we are once again in the autumn of enrollment. As work gets rolling for the second open enrollment period, it is an opportune time to reflect on lessons learned from the first open enrollment period, especially since the second one is shorter and there are fewer navigator resources available from the federal government.

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Better Health, Delivered by Phone: Q&A with Stan Berkow

Sep 4, 2014, 2:36 PM

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High-Quality Care in Low-Income Communities: Q&A with Steven Weingarten, Vital Healthcare Capital

Aug 11, 2014, 3:45 PM

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Vital Healthcare Capital (V-Cap) and the Robert Wood Johnson Foundation (RWJF) have announced a $10 million investment in Commonwealth Care Alliance (CCA), based in Boston, Mass., to help fund the organization as it rapidly expands its model of care for patients who are dually eligible for Medicare and Medicaid.

The non-profit care delivery system provides integrated health care and related social support services for people with complex health care needs covered under Medicaid and for those eligible for both Medicaid and Medicare. CCA’s expansion comes as Massachusetts continues to pioneer integrated, patient-centered care for people who are eligible for both Medicare and Medicaid though the newly created “One Care: MassHealth plus Medicare” program, one of several financial alignment initiatives for people with dual eligibility established by the Affordable Care Act (ACA) that are launching nationwide.

The loan—the first to be made by Vital Healthcare Capital, a new social impact fund based in Boston, through support from RWJF—provides funds needed by CCA for financial reserves required by the Commonwealth of Massachusetts as the agency expands the number of beneficiaries in its programs.

According to CCA Director Robert Master, the social impact goals are to:

  • Scale a person-centered integrated care model for high-needs populations.
  • Demonstrate what are known in public health as “triple aim” outcomes in health status, care metrics and cost effectiveness.
  • Train, develop and create frontline health care workforce jobs, including health aides, drivers and translators.
  • Create innovations in health care workforce engagement in coordinated care plans to better integrate into the care plan the staff members who most directly touch the lives of its members.

Over the next five years, Vital Healthcare Capital plans to establish a $100 million revolving loan fund, leveraging $500 million of total project capital for organizations working on health care reform for patients in low-income communities.

NewPublicHealth recently spoke with Steven Weingarten, CEO of Vital Healthcare Capital, about the inaugural loan and the firm’s expansion plans going forward.

NewPublicHealth: How did Vital Healthcare Capital get started and what are its overarching goals and investment criteria?

Steven Weingarten: Vital Healthcare Capital has been formed as a new non-profit financing organization to invest in quality health care and good health care jobs in low-income communities. The organization came about after a couple of years of research and development with funding from the Robert Wood Johnson Foundation, as well as from the Ford and Rockefeller Foundations and support from SEIU, the health care union. Healthcare reform is really part of a broader restructuring of health care that has enormous implications for low-income communities, and for the health care providers and plans that have been focused on these communities. Having financial capital to be able to transform health care to a better delivery model will be a critical challenge in upcoming years. So we are coming in to serve that need.

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AcademyHealth National Policy Conference: Integrating Behavioral and Physical Health

Feb 4, 2014, 2:41 PM

While behavioral and physical health have generally been separate entities in the United States, new rules under the Affordable Care Act are bringing them together—both to reduce costs and to integrate care in millions of people who face behavioral and physical health issues.

Experts at last week’s Healthy Communities Initiative forum, convened by the National Association of Counties (NACo), and this week’s AcademyHealth National Policy Conference, meeting in Washington D.C., presented strategies for combining the two. Some pilot projects are beginning. The pace is picking up largely because many people now covered under the states that have created Medicaid expansion have a range of behavioral and physical health needs. They will benefit from integration because the two are often connected—for example, diabetes has been linked to depression—and because connecting the two can reduce health care costs and reduce the number of provider visits a patient has to make.

“Behavioral health is a driving force in why people don’t get where they want to be,” said Donna Skoda, ​ Assistant Health Commissioner of Summit County, Ohio, who spoke at the NACo forum.

Several public health officers at the forum presented ideas of what works in their communities, including:

  • Hiring nurses to be care providers to assess both behavioral and physical health needs
  • Retraining behavioral health specialists, including psychiatrists, to use blood pressure cuffs and other medical equipment
  • Integrating patient files with information on mental and physical health baselines and changes
  • Opting, when possible, to deliver care in physical health offices rather than counseling offices, since physical practitioner clinics already have devices needed such as scales

Presenters at the AcademyHealth policy conference stressed cost savings. For example, Washington state will participate in a federal demonstration project for beneficiaries dually eligible for Medicare and Medicaid. Under the demonstration, the health plans will be responsible for a full range of services—including mental health; chemical dependency; long-term services and supports; and medical care—under a single capped rate.

“Integrated care needs to be the rule, not the exception,” said Charlene Le Fauve, a deputy director of the National Institute of Mental Health.

Le Fauve said new technologies can be an important factor in delivering care including mobile devices and internet tools, which can be used at provider offices, clinics, and in homes if communities provide those services.

Other ideas being funded include training community workers for brief interventions which may be able to keep many people with mental illness out of both the emergency room and the hospital. Phone intervention is also being studied, said Le Fauve.

This commentary originally appeared on the RWJF New Public Health blog.

NACo Conference: Transitioning Jail Inmates to Community Care

Feb 3, 2014, 11:59 AM

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A key session at the National Association of Counties (NACo) Health Initiatives Forum held last week in San Diego focused on the opportunities and implementation challenges of the Affordable Care Act for inmates of county jails.

Most county jail inmates are there awaiting trial because they can’t afford bail, and a large percentage have physical and/or mental health problems. While in jail, the cost for their health care falls to the county; Medicaid and other benefits inmates have in the community end once they enter the jail system, and many have no benefits. Typically, the care inmates received in jail ends on release since there is generally no entity to help them transition to community benefits and care.

And benefits under the Affordable Care Act are generally elusive for inmates—and counties—desperate for care and a break on the high cost of health care for inmates. While just about all inmates would qualify for coverage under the Affordable Care Act either through health insurance marketplaces or Medicaid expansions in those states that have changed their Medicaid rules under the health law—expanding Medicaid benefits to those without children who qualify financially because of low incomes—current laws do not permit inmates to be covered for health care costs under Medicaid while in jail, except for hospitalizations while they’re incarcerated.

Many counties in states that have expanded Medicaid to include low-income adults without children have petitioned their state Medicaid offices to amend current rules and allow coverage for health care under Medicaid during incarceration.

However, counties are taking initiative to help inmates sign up for coverage that will kick in on their release, reducing the chance for recidivism and improving the chance for healthier and more productive lives. For example, last week in San Francisco the city sheriff sent a bill to the city’s Board of Supervisors that would make the sheriff’s office responsible for helping inmates sign up for the Affordable Care Act.

At the NACo meeting, Farrah McDaid Ting, Associate Legislative Representative for Health and Human Services at the California State Association of Counties, said a key issue both for county budgets and for the health of people released from jail into the community is that without benefits and a transition to care, often care was only sought afterward and delivered when there is a crisis. Ting says among the requests being made in California is to have Medicaid suspended rather than terminated for people in jail under a year, which would allow a person to transition back to care immediately on release.

Another critical need in jail is technology infrastructure to allow inmates to be signed up. Some counties in California, according to Ting, are using outside nonprofit groups to sign up eligible inmates before release.

“What we want to reduce is that person ending up back in jail,” said Ting.

This commentary originally appeared on the RWJF New Public Health blog.

Reforms in Oregon’s Medicaid Program and Emergency Department Use

Jan 16, 2014, 5:23 PM, Posted by Susan Dentzer

 Inter Professional Nursing

“Past performance is no guarantee of future results,” goes the boilerplate warning on financial investments. The caution is worth keeping in mind in the wake of a recently published study that found that expanding Oregon’s Medicaid program in 2008 led to a 41 percent increase in emergency department (ED) use by many of those newly covered by the program.

The study, by an esteemed group of researchers (some of whom are affiliated with the National Bureau of Economic Research) is the latest to emerge from the Oregon Health Insurance Experiment. This series has focused on the effects of 2008-2009 policy changes that led thousands of previously uninsured Oregonians to enroll in Medicaid. The latest study found that costly visits to the ED rose across the board over a two-year period, including for relatively simple conditions, such as headaches, that could easily have been treated in primary care settings.

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RWJF Clinical Scholars Podcast: NY Health Commissioner Discusses Health Reform

Dec 18, 2013, 9:00 AM

In his first two years in office, New York State Health Commissioner Nirav Shah, MD, MPH, has been deeply engaged in the state’s ambitious Medicaid redesign process. Shah oversees the $50 billion state public health agency and has been praised for his health system reform efforts. Moving forward, he is focusing on issues such as securing federal funding for “supportive housing” to offer chronically ill, low-income individuals subsidized living quarters in building complexes that also contain in-house medical and social services.

Shah, an RWJF Clinical Scholar alumnus, discusses this and more in the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars Health Policy Podcast, a monthly series co-produced with Penn’s Leonard Davis Institute of Health Economics and hosted by RWJF Clinical Scholar Chileshe Nkonde-Price, MD.

The video is republished with permission from the Leonard Davis Institute.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Do Mergers with State Medicaid Programs Result in Cuts to State Public Health Department Funding?

Dec 9, 2013, 9:00 AM, Posted by Paula Lantz

Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW).  Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*

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It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.

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Who Will Benefit From Medicaid Expansion and What Will it Mean for These Patients?

Oct 18, 2013, 10:00 AM, Posted by Tammy Chang

Tammy Chang, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.

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Over kitchen tables as well as on Capitol Hill, the discussion continues over the Affordable Care Act including who will benefit and what it means for everyday Americans.

To shed light on this debate, my co-author Matthew Davis, MD, MAPP, and I recently published a study that describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act.  The study, published in the Annals of Family Medicine, uses a national source of data used by many other researchers who look at national trends—such as high blood pressure and obesity—called the National Health and Nutrition Examination Survey (NHANES).

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A Success Story: Health Insurance Enrollment in Colorado

Oct 16, 2013, 10:00 AM

Sue Birch, MBA, BSN, RN, is executive director of the Colorado Department of Health Care Policy and Financing, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2002).

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Now that I have caught my breath, I wanted to share the Colorado report on Obamacare’s October 1st Birthday!  Our state has decided to expand our Medicaid program and to form our own marketplace for Coloradans to shop and compare health insurance plans.  These changes will help us cover many uninsured Coloradans. 

In its first week, Connect for Health Colorado, our state’s health insurance marketplace, successfully attracted more than 162,941unique website visitors, had 9,658 calls and chats to the service center, and 18,174 accounts created.  We think this is a strong start and know that it will take time for Coloradans who have not had insurance before to learn about their options and apply for coverage.  We are working across state government to help make this happen.       

At my department, Health Care Policy and Financing, Coloradans can enroll through our new modularized interoperable cloud-based system, PEAK.  We had more than 9,000 applications come through this site in the first 10 days of October.  It is foundational to our desire to increase new consumerism and greater client responsibility by walking through a self-enrollment process.  Our website is Colorado.gov/PEAK and we have seen record traffic to the application site.

Overall, the marketplace opening went quite smoothly for Colorado—the exchange opened successfully, Medicaid began, and our technology functioned efficiently for being such a large, complex system. With the marketplace now up and running, individuals, families, and small employers can start making appointments with Health Coverage-Guides, learn about plan options, and apply for insurance when ready.

This is an exciting moment in health care history and we are proud to be working with partners across our state and our nation to provide affordable health insurance options to all residents of Colorado!

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.